With a hefty, decades-long industry in the U.S. and increasing uses for a wide array of medical conditions, medical cannabis is commonly used for symptom management in America and countries around the world. Like it or not, medical cannabis is now part of the contemporary world of medicine.
Despite this, physicians still receive little training around cannabis in medical school and often rely mostly on anecdotal evidence. By proxy, medical students don’t generally receive formal education around recommending medical cannabis or managing its use.
Now, a new qualitative study from Kiran C. Patel College of Osteopathic Medicine, “Medical Students’ Attitudes, Knowledge, and Beliefs about Medical Cannabis: A Qualitative Descriptive Study,” aims to take a closer look at medical students’ perceptions of medical cannabis, including its efficacy, appropriateness in medicine, possible adverse effects, and patient value.
The qualitative study sought to answer the question: What do medical students know and think about medical cannabis? Researchers specifically aimed to conduct in-depth focus group discussions with osteopathic medical students to identify their attitudes, knowledge and beliefs around medical cannabis and to analyze the data from these conversations to identify emerging themes to guide new medical education curriculum strategies.
Regardless of the prevalence of medical cannabis in medicine today, the study’s introduction notes that physicians know “little” about the therapeutic properties of medical weed, i.e. what health conditions medical cannabis is effective in treating, and less about recommending it, for example discussing adverse effects and proper dosage. Researchers say this may be due to the lack of formal education physicians receive in med school.
“What we do know, however, is that physicians tend to rely on a combination of unreliable sources to obtain information, most of which are anecdotal reports,” researchers write.
Because of the enduring stigma, researchers say that medical cannabis is generally discussed in school during lectures on other Schedule 1 drugs and may only include its harmful effects as a “street drug,” with administrators feeling uncomfortable integrating the therapeutic uses of cannabis into school curricula.
All study sessions were held in June 2022 among students who had just completed their first, second, or third year of school. The study utilized a semi-structured interview guide created by researchers, with Zoom interviews among eight focus groups and a total of 83 medical students.
Each group lasted between 60-75 minutes, guided by the following content areas: beliefs about cannabis’ therapeutic utility, perceived knowledge about medical cannabis, the role of the physician regarding medical cannabis, concern for adverse effects, and desire for education around medical cannabis in school.
The four themes that emerged from the interviews included erroneous beliefs around medical cannabis, unreliable sources of information, mixed attitudes toward legalization and desire for medical cannabis education in school.
Overall, participants reported what they believed were potential therapeutic uses of medical cannabis, including cancer care, AIDS care, chronic disease management, pain management, digestive issue, appetite stimulation, help with nausea, Parkinson’s disease, anxiety and depression, glaucoma, PTSD, sleep disorders and multiple sclerosis.
Some agreed that medical cannabis may have a viable role in medicine, though there were also concerns around the potential harmful effects. Many also believed cannabis was highly addictive, either physiologically or psychologically. Several participants also said that patients are not capable of managing their own medical cannabis use or that patients might misuse medical cannabis by giving it away or selling it to others.
Some participants said they were comfortable with physicians recommending medical cannabis through telehealth conferencing, while others said it should be done face to face, with one participant noting that it “opens up an opportunity for people to beat the system.” Researchers also noted that participants often spoke about recreational cannabis without distinguishing it from medically prescribed cannabis, with the facilitators reminding participants in each of the eight focus groups “at least twice” to be mindful of the distinction.
Researchers said it was “unsettling” how participants spoke of the dangers of medical cannabis use with unsubstantiated authority, citing that medical student concerns around medical cannabis have been reported in previous studies.
“Equally unsettling is the idea, according to participants, that patients are incapable of recognizing signs of their illness and knowing their own bodies, which could be dangerous to the patient as they ‘do not know what they need for their condition, or they do not know what they are feeling.’”
Regarding information sources, participants reported they got their information about medical cannabis anecdotally, from social media and from news clips only. Only two of the 83 participants reported that they searched library databases or read scientific journal articles to obtain information about medical cannabis.
Participants also reported that their school didn’t provide curricular-based education on medical cannabis, though it did provide information on the harmful effects of recreational cannabis. Many participants also commented that they believe there is “little or no scientific research available” on medical cannabis, which is why they rely on social media for information.
Most of the participants agreed that medical cannabis should be federally legalized and reclassified from being a Schedule 1 drug. Many also shared the opinion that medical cannabis should be “rigorously controlled by physicians” and that no other healthcare provider (like pharmacists or nurses) should be able to recommend or prescribe medical cannabis.
Finally, participants discussed their exposure to medical cannabis in school, commenting that their knowledge of medical cannabis was “lacking” and that they would benefit from more medical cannabis education while in school. The majority of participants felt that medical cannabis education should be integrated through the four years of undergraduate training, including medical cannabis information (like therapeutic benefits, potential risks, and adverse effects, medical contraindications, legalities and dosing recommendations) incorporated into the curriculum, namely in pharmacology and/or systems courses.
“I think there’s plenty of opportunities for us to be able to find ways to integrate MC in a number of lectures…” one participant said. “Professors can provide links to the citations they used…we’re not being trained to become experts in MC, but we certainly should be familiar with what current literature is available. To be able to find a way to incorporate it into a GI lecture to incorporate segments of it and neurology into biochemistry…I think that’s totally feasible in a pharmacology course.”
Ultimately, researchers concluded that medical cannabis seems to be a significant issue for medical trainees, especially given that they may be required to recommend it to patients or manage coexisting therapies with patients in their careers. Despite using unreliable sources for information about medical cannabis, most held favorable views around reclassifying cannabis as a Schedule 1 drug, legalizing medical pot on a federal level and that medical cannabis education should be integrated into medical school curriculum.
“Research studies continue to show the efficacy for medicinal use and proper dosing as well as the potential adverse effects of MC use, rendering accurate education important for medical programs to ensure MC readiness in future physicians,” the study concludes.